Validation of a phone app for epilepsy diagnosis in India and Nepal

• We devised a diagnostic aid to determine whether episodes of altered consciousness are epileptic or not.
• We presented this as a phone app.
• We tested it in three populations and compared it to the diagnosis of an experienced clinician.
• The app correlated well with clinical diagnosis.
• This app could contribute to reducing the epilepsy treatment gap.

PurposeUntreated epilepsy is a major global public health problem with more than 20 million people not being treated for an easily treatable disease. In part this is due to a lack of trained doctors. There are many more non-medical health workers than doctors and they could have an important role in diagnosis and treatment of epilepsy if they had some tools. We have previously described such a tool to distinguish epileptic episodes from other causes of altered consciousness and here present its validation in three new populations.MethodsThe tool was presented as a phone app where the answers to 11 questions provided a probability score which indicated whether episodes might be due to epilepsy or not. It was applied either by non-medical volunteers, health workers, or inexperienced doctors to 132 patients in three separate populations in India and Nepal and compared with the “gold standard” diagnosis of a neurologist with expertise in epilepsy.ResultsThere was good agreement between the app score and the neurologists’ diagnoses (weighted kappa = 75.3%). An app score of 90 or greater had a sensitivity of 88% and a specificity of 100% for diagnosing epilepsy. The app was easy to use with little training and took about 5 min to administer.ConclusionA tool presented as a phone app can be used by non-medical health workers to identify episodes as epileptic or not with good accuracy. It needs to be evaluated more widely but has the potential to play a part in reducing the epilepsy treatment gap.